Risk factors for administration of additional neuromuscular block reversal in adults undergoing general anaesthesia: a single centre retrospective case-control study

Background Residual neuromuscular block continues to be a modifiable risk factor for major postoperative pulmonary complications in adults. Methods We performed a large retrospective case-control study at a single center to evaluate both the prevalence and risk factors for clinically significant residual neuromuscular block following reversal with neostigmine. Results We found that clinically significant residual neuromuscular block after reversal with neostigmine is rare, occurring in 3.2% of adults. Risk factors for incomplete reversal with neostigmine following rocuronium administration included: increasing age, ASA physical class status III and IV, a cumulative dose of rocuronium > 0.43 mg center dot kg(-1)hr(-1), an interval of < 48 min between the last dose of rocuronium and neostigmine administration, a qualitative train-of-four count < 2 at the time of reversal with neostigmine, emergency case status, thoracic surgery, and African American race. Conclusion Reversing neuromuscular block with sugammadex in patients at higher risk of incomplete reversal with neostigmine can improve outcomes and reduce costs, especially in cases where qualitative assessment is utilized or when quantitative monitoring is unavailable.